Talk about a Cadillac plan

Today’s editorial: With Medicaid accounting for so much of the state budget and New York so far focusing only largely on providers, it is time to take a look at just how much the state can afford in a program that ranks as the costliest in the nation.

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Imagine a household in which Mom and Dad don’t have enough money to pay for everything they need or want to do — not an altogether unusual scenario nowadays.

Imagine, then, that Mom and Dad declare that the belt tightening has to start right now. That means less money for all sorts of things, including, unfortunately, medical expenses.

But, wait, they add: the family isn’t actually going to go to the doctor any less or think twice about whether every emergency room visit really is an emergency. It’s just going to pay less, and hope the doctors and hospitals don’t mind.

Unrealistic? Of course. But that’s essentially how New York has been cutting costs when it comes to one of the largest single areas of state spending, namely, Medicaid, the health care program for the poor and disabled.

As lawmakers try to stop a flood of mid-year red ink and billions more in future deficits, there is no question that it must look at bringing down the $49 billion cost of New York’s Medicaid program.

There are really only three ways to do this: pay providers less, limit enrollment, or offer less generous benefits.

So far, the state has looked mainly at the first option while ignoring the others. So even after $3.9 billion in health care cuts in the last year and a half, and another $287 million on the way under Gov. David Paterson’s deficit reduction plan, New York still wants and expects pretty much the same service.

Which might explain why, for all its talk of tightening health care costs and going after all that supposed fraud in the Medicaid program, New York has by far and away the costliest Medicaid system in the United States. According to figures from the Kaiser Family Foundation, New York in the 2007-2008 fiscal year spent $44.3 billion to cover 5.1 million people through Medicaid. California spent less — $35.9 billion — to insure more than twice as many people — 10.5 million. New York spent $7,927 per enrollee, California, just $2,740.

Why? In large part, because New York’s Medicaid benefits are far more generous than the federal government’s standards for Medicaid. According to state Health Department figures, the state spends almost $11 billion more to provide clinical and dental services, medicine, transportation to and from appointments, personal care and services for the mentally retarded than the federal government requires.

There is no question that giving the poor the best care we can afford is laudable. And we by no means advocate draconian cuts in health care for those who need public support.

But New York clearly is not having an honest discussion about reining in Medicaid spending when it won’t take a hard look at a program whose cost far exceeds that of any other state. And the state can only bleed health care providers so much before it finds that the patient has lost the doctor.